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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES & RELATED

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Monday, September 13, 2021

Ketamine for agitation

First10EM - By Justin Morgenstern - September 13, 2021
Paper #1
Lin J, Figuerado Y, Montgomery A, Lee J, Cannis M, Norton VC, Calvo R, Sikand H. Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study. Am J Emerg Med. 2021 Jun;44:306-311. doi: 10.1016/j.ajem.2020.04.013. PMID: 32340820
Paper #2
Barbic D, Andolfatto G, Grunau B, Scheuermeyer FX, Macewan B, Qian H, Wong H, Barbic SP, Honer WG. Rapid Agitation Control With Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial. Ann Emerg Med. 2021 Aug 2:S0196-0644(21)00433-9. doi: 10.1016/j.annemergmed.2021.05.023 PMID: 34353650
Bottom line
There are now 2 RCTs that demonstrate that ketamine will result in more rapid sedation than haloperidol plus a benzodiazepine, but that seems to come at the cost of an increase in adverse events. Ketamine makes sense in carefully selected patients, and may be particularly helpful in the prehospital setting. Regardless of sedative choice, agitated delirium is an emergency that warrants our full attention.